BACKGROUND: Feedback about performance may optimize motor relearning after stroke. OBJECTIVES: Develop an international collaboration to rapidly test the potential efficacy of daily verbal feedback about walking speed during inpatient rehabilitation after stroke, using a protocol that requires no research funds. METHODS: This phase 2, single-blinded, multicenter trial randomized inpatients to either feedback about self-selected fast walking speed (daily reinforcement of speed, DRS) immediately after a single, daily 10-m walk or to no reinforcement of speed (NRS) after the walk, performed within the context of routine physical therapy. The primary outcome was velocity for a 15.2-m (50-foot) timed walk at discharge. Secondary outcomes were walking distance in 3 minutes, length of stay (LOS), and level of independence (Functional Ambulation Classification, FAC). RESULTS: Within 18 months, 179 participants were randomized. The groups were balanced for age, gender, time from onset of stroke to entry, initial velocity, and level of walking-related disability. The walking speed at discharge for DRS (0.91 m/s) was greater (P = .01) than that for NRS (0.72 m/s). No difference was found for LOS. LOS for both DRS and NRS was significantly shorter, however, for those who had mean walking speeds >0.4 m/s at entry. The DRS group did not have a higher proportion of FAC independent walkers (P = .1) and did not walk longer distances ( P = .09). CONCLUSIONS: An Internet-based collaboration of 18 centers found that feedback about performance once a day produced gains in walking speed large enough to permit unlimited, slow community ambulation at discharge from inpatient rehabilitation.
RCT Entities:
BACKGROUND: Feedback about performance may optimize motor relearning after stroke. OBJECTIVES: Develop an international collaboration to rapidly test the potential efficacy of daily verbal feedback about walking speed during inpatient rehabilitation after stroke, using a protocol that requires no research funds. METHODS: This phase 2, single-blinded, multicenter trial randomized inpatients to either feedback about self-selected fast walking speed (daily reinforcement of speed, DRS) immediately after a single, daily 10-m walk or to no reinforcement of speed (NRS) after the walk, performed within the context of routine physical therapy. The primary outcome was velocity for a 15.2-m (50-foot) timed walk at discharge. Secondary outcomes were walking distance in 3 minutes, length of stay (LOS), and level of independence (Functional Ambulation Classification, FAC). RESULTS: Within 18 months, 179 participants were randomized. The groups were balanced for age, gender, time from onset of stroke to entry, initial velocity, and level of walking-related disability. The walking speed at discharge for DRS (0.91 m/s) was greater (P = .01) than that for NRS (0.72 m/s). No difference was found for LOS. LOS for both DRS and NRS was significantly shorter, however, for those who had mean walking speeds >0.4 m/s at entry. The DRS group did not have a higher proportion of FAC independent walkers (P = .1) and did not walk longer distances ( P = .09). CONCLUSIONS: An Internet-based collaboration of 18 centers found that feedback about performance once a day produced gains in walking speed large enough to permit unlimited, slow community ambulation at discharge from inpatient rehabilitation.
Authors: B Dobkin; D Apple; H Barbeau; M Basso; A Behrman; D Deforge; J Ditunno; G Dudley; R Elashoff; L Fugate; S Harkema; M Saulino; M Scott Journal: Neurology Date: 2006-02-28 Impact factor: 9.910
Authors: Arlene Schmid; Pamela W Duncan; Stephanie Studenski; Sue Min Lai; Lorie Richards; Subashan Perera; Samuel S Wu Journal: Stroke Date: 2007-05-17 Impact factor: 7.914
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson Journal: BMC Neurol Date: 2007-11-08 Impact factor: 2.474
Authors: Andrew K Dorsch; Seth Thomas; Xiaoyu Xu; William Kaiser; Bruce H Dobkin Journal: Neurorehabil Neural Repair Date: 2014-09-26 Impact factor: 3.919
Authors: HaoYuan Hsiao; Thomas M Zabielski; Jacqueline A Palmer; Jill S Higginson; Stuart A Binder-Macleod Journal: J Biomech Date: 2016-10-08 Impact factor: 2.712